Search for tag: "asthma"

Interviewer: What should you do if someone you know has a very severe asthma attack? We're going to find out next on The Scope.

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Interviewer: Dr. Madsen, I want to do a scenario here. If somebody has a very severe asthma attack, and I'm there, what should I do? I would imagine that that person knew they had asthma, and I'd hoped they had an inhaler. Would that be the first place I'd start?

Dr. Madsen: Probably so, but you also have to think, is this someone you just need to call 911 for and get them to the ER. And in my mind, the way I really judge the severity of an asthma attack is, first of all, can the person talk to me? If a person cannot breathe well enough, where they can't really get out more than say a one word answer, that's really severe. And in that situation, before I go looking for their inhaler, I'd say call 911. Get the ambulance there, get them to the ER, because even if they take a couple of puffs of their inhaler, it's probably not going to do much in that situation.

Interviewer: All right, so super severe like that, don't even mess around with it, don't hesitate, call 911, get the professionals there.

Dr. Madsen: I would.

Interviewer: And if they're not quite that severe, they're able to get some sentences out, they're able to talk to you, what would you do at that point?

Dr. Madsen: Usually in that situation, if they have asthma, they have an inhaler somewhere, and so they might say "Hey, can you go grab my inhaler for me?" Maybe they're feeling kind of winded, they just want to sit down, try and relax a little bit. But they're talking to you, they're not breathing so fast they just can't get anything out. You look at them, they look like they're working a little bit to breathe, but it's not like when they breathe you see all of their neck kind of sucking in because they're trying to get air in. So it's not a real severe case, so certainly I think an inhaler is going to help there.

Even in those situations, if it's that bad they might take a couple of puffs of their inhaler, they might feel a little bit better. But I often find even in those scenarios, they may need some more treatments in the ER, including possibly steroids which are going to help out as well, which typically they don't have at home.

Interviewer: All right, one of the ABCs is breathing. And any time that somebody is having trouble breathing, that is one of the rules that you use that you should go to the ER. So it's crucially important. What should you do at that point, while you're waiting for help to arrive, whether it's the inhaler didn't work, maybe they didn't have one, they ran out, they are struggling breathing. Is there anything you can do to help them at that point?

Dr. Madsen: Really the best thing you can do is whatever you can do to just keep them calm, because if someone is having trouble breathing, that's going to make you feel anxious. You can just imagine that drive you have to breathe, and when you're struggling with that you're going to feel incredibly anxious. The problem with asthma is that anxiety is going to make it even more difficult to breathe, it's just going to compound the problem.

So realistically, the only thing you can do there besides say having them take some puffs of their inhaler, would be to do whatever you can do to help them calm down. Turn on the TV, turn on some music, something just to help them relax a little bit, while you're waiting for the ambulance. Reassure them they're going to be fine, tell them you're breathing okay, you're talking to me, this is great, ambulance should be there hopefully within 5 to 10 minutes. And at that point, they're going to get them on some continuous breathing treatments and get them where they need to be.

Interviewer: So in summer, it sounds like if somebody is having a severe attack like that, just call 911 because there are things that you can do in the emergency room to help them, and just a breathing problem is not something you want to mess with.

Dr. Madsen: That's exactly right. Like you said, we talk about the ABCs, that's what B stands for. Once you talk about breathing, you've got to address it, and usually you're not going to be successful at home. Keep in mind that asthma is a very serious disease. It kills thousands of people every year, so you have to take it seriously to get them the help they need.

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Dr. Jones: Good bacteria and bad bacteria. We are being bombarded by information about the bacteria with which we share our bodies, but what about our babies? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Healthcare, and this is Babies and Good Bacteria on The Scope.

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Dr. Jones: We have previously talked about how babies benefit from exposure to different kinds of bacteria. Babies who have a wider exposure to bacteria may have less obesity, diabetes, asthma and autoimmune disease. So it is okay to put your baby on the floor, and it is okay, mostly, to let your dog lick your baby.

Now, a baby in the uterus the day before it is born is living in a mostly sterile environment. The passage through the mom's birth canal during labor allows mom's bacteria to colonise the baby, and breastfeeding allows some more.

The vaginal bacteria in healthy pregnant women are largely lactobacillus, which is a bacteria that can help babies metabolize milk, but what about babies that are born by cesarean section? There are some data to suggest that babies born by cesarean, and that is about 30% of babies in this country, may have more autoimmune diseases like asthma, type 1 diabetes and other conditions, and food allergies than babies that were squeezed out through the mom's vagina, especially babies that were born via cesarean, without moms having been in labor for a while.

Okay, so it isn't a huge difference in which babies get some diseases, but if you were planning a caesarean, could you do something about it? A short report has just been published in the Journal of Nature Medicine suggesting that you can. This was a very small study of 18 moms and their babies at the University of Puerto Rico in San Juan. Seven babies were born vaginally and 11 babies were born by elective cesarean section without labor.

Four women who were scheduled to have a caesarean had a bit of gauze put in their vagina, then removed and put in a sterile container before the cesarean was performed. A few minutes after the babies were born they were dried off and four of the babies had gauze wiped over their skin. Eleven other babies did not. Over the following month, the moms and their babies had their microbiome, their bacterial ecosystem, assessed. The babies who were treated with the gauze had skin bacteria more like their moms and more like the babies born vaginally. The babies born from cesarean who did not have the gauze treatment had bacteria more like that from the hospital environment, and less like their mom's vaginal environment.

The babies who had the gauze treatment weren't exactly like babies born vaginally in that their gut bacteria weren't as varied and abundant as babies born vaginally. This could be for several reasons. One is the fact that moms getting a cesarean often get antibiotics to decrease the risk of infection in their cesarean incision or their uterus. Infection is relatively common in cesarean incisions, and that is why we give women antibiotics routinely who are having a cesarean.

So lots goes on in labor that involves moms exchanging bacteria with their babies. Now we don't know if these babies with the gauze treatment will grow up to be healthier or not. And we don't know if there are some moms with bacteria or viruses in their vagina that shouldn't be shared with their babies.

A bigger study is ongoing right now at New York Hospital. However, this idea is being disseminated in mothers' blogs and magazines, and women are asking for it. The professional medical organizations haven't recommended it yet, and I am pretty sure I would add the statement, "Don't do this at home," but if you're interested you should ask your OB.

There is so much to think about when you're going to be a new mom, and this wouldn't be number one on my list, but it is something to know as we learn more and more about the world in which we live and into which we bring our babies.

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Dr. Gellner: Even if cats and dogs make you sneeze, will you save your kids from aggravating allergies by getting them a pet? It's a theory we'll discuss today on The Scope. I'm Dr. Cindy Gellner.

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Dr. Gellner: Early pet exposure reducing the risk of allergies in children. It's part of something called the hygiene hypothesis, and it's been tossed around for a few years now. Evidence is mounting that it may be true. Studies found that exposure to pets in early years of a child's life might significantly lower the risk according to some pediatric allergy specialists.

The allergy researchers followed a group of about 500 children almost equally split between boys and girls from birth to age seven. Children were checked regularly with blood tests to measure antibodies that cause allergies, skin reaction tests that show if someone is sensitive to an allergy, and a breathing test to measure their lung function commonly used to detect if their child has an asthma flare or not.

The researchers also collected information on exposure to cigarette smoke, home and daycare environments and measured allergen levels in the household such as dust and other air samples. They also asked about pets in the home.

So the allergists found that children who lived with two or more animals were significantly less likely to have a positive skin test, which signifies a reaction to the allergen rather than those who had no exposure to pets. Children with pets were also less likely to have allergen antibodies in their blood. Boys especially seem to benefit from pet exposure. Not only did they have lower antibody levels, they had better lung tests and less evidence of asthma if there were two or more cats or dogs in the house.

The study adds to the growing literature about the hygiene hypothesis that the cleaner we live, which is common in our western world lifestyle, the more likely we'll get asthma and allergies. It confirms that observation that children with a history of pet exposure in the first years of life may have less asthma. Boys do tend to get more asthma and allergies, though.

The study falls short of proving that pets can prevent allergies and asthma. You shouldn't automatically just go out and get two dogs and two cats. It's a correlation that may be true but it hasn't been proven yet. It could be that the study shows that only children who have a risk of allergy or asthma tend not to have cats or dogs in the house.

By working on this same hygiene hypothesis, pets may not even be a necessary factor in increasing a child's immunity. Siblings might also play the same role as pets. Infections in early life, especially with viruses, may help drive the immune system away from being sensitive and causing allergies. Kids can get the same kind of exposure from older siblings in the first month of a child's life. Usually the older siblings will bring home lovely viruses from school, or the child themselves will be exposed to viruses at daycare.

Just like we say don't go out and get two dogs or two cats just to keep your kids from getting allergies, we don't necessarily mean you have to put them in daycare in order to expose them to these viruses. More studies need to be done following children in their early lives before any conclusions can be made about the hygiene hypothesis.

So does this mean you should go out and get a pet? Well, not so fast. If there's someone in the house who has an allergy to a dog or cat, you really don't want to put that family member through misery. Also, genetics play a large role as well. Children have a one in three chance of developing allergies if just one of their parents has allergies. If both of their parents have allergies, their risk is nearly 70%. The risks increase by similar amounts for asthma. Pets are a lot of responsibility, too. Be sure to think about all family members, pets included, if considering a dog or cat.

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Dr. Kirtly Parker Jones: "Don't put that in your mouth." How often have we said that our babies on the floor, who picked up the dog's bone and starts to chew on it? We try to keep our infants safe from diseases by keeping them away from anything dirty, by keeping their environment ultra clean. But maybe a little dirt in our infant's beginnings helps them in the future life. This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at the University Healthcare, and this is the down and dirty about babies and allergies today on The Scope.

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Dr. Kirtly Parker Jones: How does our body learn what the immune system should fight off and what it should accept? The immune starts developing in the womb, but the real work begins at delivery. The bacteria that are very important and populating the newborn's gut comes from the mother's vaginal flora and her skin, and the bacteria the baby experiences is in early life.
Having a lot of different bacteria is a good thing. Babies born by a Caesarean section without labor have more asthma, more autoimmune diseases, and eczema. But what about after birth? We evolved our immune system by living in the dirt, not with hand sanitizer. It's a good thing not to be allergic to your environment, so what is the evidence that we should let our babies suck on their pacifier when it falls in the dirt or chew on the dog's bone? Today, we're going to talk about babies and allergies.
It's long been known that many of the autoimmune diseases that we see in the U.S.; asthma, eczema, autoimmune colitis like Crohn's Disease are very rare in third world countries or, to be politically correct, developing countries. A mounting body of research suggests that exposing infants to germs may offer them greater protection from illnesses such as allergies and asthma later on in life. There's something called the Hygiene Hypothesis which holds that when exposure to parasites, bacteria, and viruses is limited early in life, children face a greater chance of having allergies, asthma, and other diseases later in adulthood. In fact, kids with older siblings who grow up on a farm or who attended daycare early in life seem to show lower rates of allergies.
Just as a baby's brain needs stimulation, input, and interaction to develop normally, the new research is read to your kid from birth, not just put them in front of the TV, the young immune system is strengthened by exposure to everyday germs so that it can learn, adapt, and regulate itself.
It's been observed that infants from farm families, especially those with older siblings, have much less asthma and allergies to pets or other animals. I think old siblings thing is that the older sibling puts their dirty hands on the infant, and this is not such a bad thing, as it turns out. It is innate behavior of infants to pick up everything and put it in their mouths, including their hands, their feet, and anything they can reach. Well, maybe there's a reason for that. They aren't hungry, and adults don't do that. Even children over 3 don't do that anymore. So maybe they are priming their gut with bacteria to help them later in life. That's just a guess.
Recently, it's been shown that bacteria in the newborn's gut are important in regulating the developing immune system. And finally, a new study from John Hopkins looked at asthma in inner city children. Infants were followed from birth to 3 years. Now, we know inner city children have high rates of asthma and triggers include cockroach droppings, mouse, and cat dander. So they tested these children and their homes for these exposures as well as doing a quote "bacterial analysis" of their home. Infants who were exposed to cockroach droppings, mouse, and cat dander and a wide variety of bacteria had a 17% incidence of wheezing by age 3 compared to 51% of wheezing in kids who weren't exposed to these factors as infants. Wheezing in early childhood can be a sign of future asthma in children. The important and curious fact is the exposure has to happen in the first year of life to be protected.
We know that our fear of germs and our babies comes from the knowledge that around the world, the number one killer of newborns is infectious diarrhea from unclean water, so we don't want to expose our kids to bacteria and unclean water and from people who are sick. These germs are sick people germs, not from the environment. We should take care about exposing our infants to people with diarrhea and upper respiratory tract infection, but I'm talking about crawling in the dirt.
So what should we do as moms and grandmas? If the child is otherwise healthy and doesn't already have a compromised immune system from disease, its okay to let the dog lick the baby's face, and the binky doesn't have to be sterilized if it drops in the dirt. Let the infant sit or lay on the ground or the floor. A little dirt won't hurt her none. So that's the down and dirty about babies and their developing immune systems. Stay tuned because this is an area of research that's growing very quickly, and thanks for joining us on The Scope.

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